Preoperative soluble cluster of differentiation 40 ligand level is associated with outcome of pulmonary endarterectomyCentral MessagePerspective
Ayako Shigeta, MD, PhD,
Nobuhiro Tanabe, MD, PhD, FCCP,
Akira Naito, MD, PhD,
Hajime Yokota, MD, PhD,
Fumiaki Kato, MD, PhD,
Takayuki Jujo-Sanada, MD, PhD,
Seiichiro Sakao, MD, PhD,
Keiichi Ishida, MD, PhD,
Masahisa Masuda, MD, PhD,
Koichiro Tatsumi, MD, PhD
Affiliations
Ayako Shigeta, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan; Address for reprints: Ayako Shigeta, MD, PhD, Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-Ku Chiba 260-8670, Japan.
Nobuhiro Tanabe, MD, PhD, FCCP
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
Akira Naito, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
Hajime Yokota, MD, PhD
Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
Fumiaki Kato, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
Takayuki Jujo-Sanada, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
Seiichiro Sakao, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
Keiichi Ishida, MD, PhD
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Cardiovascular Surgery, Eastern Chiba Medical Center, Togane, Japan
Masahisa Masuda, MD, PhD
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Cardiovascular Surgery, Eastern Chiba Medical Center, Togane, Japan
Koichiro Tatsumi, MD, PhD
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
Objective: Soluble CD40 ligand (sCD40L) is associated with some pathobiological states. However, whether sCD40L in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA) is associated with perioperative pulmonary hemodynamics and surgical outcomes has not been elucidated. Here we aimed to investigate whether sCD40L is a useful serologic biomarker of poor surgical outcome of PEA in patients with CTEPH. Methods: Ninety patients with CTEPH who underwent PEA were enrolled. Independent preoperative parameters were examined, including sCD40L related to lower cardiac index (CI), higher pulmonary vascular resistance (PVR), and poor surgical outcomes after PEA, according to the multivariate logistic regression analysis. In addition, the area under the curve (AUC) value of sCD40L to predict poor surgical outcomes was compared with the AUCs of D-dimer and C-reactive protein (CRP). The generalizability of this study model was tested by a 5-fold cross-validation analysis. Results: Multivariate logistic regression analysis showed that high sCD40L level was related to postoperative lower CI, higher PVR, and poor surgical outcomes independent of other preoperative parameters. The AUC value of sCD40L to predict poor surgical outcomes was higher than those of D-dimer and CRP. A sCD40L cutoff value of 1.45 ng/mL predicted poor surgical outcomes with 79.3% sensitivity and 67.3% specificity. The 5-fold cross-validation analysis showed the effectiveness of our model's performance. Conclusions: Preoperative sCD40L level could be a promising serologic biomarker associated with poor surgical outcomes in CTEPH. In addition to known preoperative parameters, the biomarker might have the potential to identify patients at high risk of PEA, thereby reducing the mortality rates.
